Anthem Investigator I, II or Senior-PS16757 in Chicago, Illinois
Investigator I, II or Senior-PS16757
Location: Atlanta, Georgia, United States
Requisition #: PS16757
Post Date: Jan 11, 2019
Your Talent. Our Vision. At Anthem, Inc., it’s a powerful combination, and the foundation upon which we’re creating greater access to care for our members, greater value for our customers, and greater health for our communities. Join us and together we will drive the future of health care.
This is an exceptional opportunity to do innovative work that means more to you and those we serve at one of America's leading health benefits companies and a Fortune Top 50 Company.
This is a job family posting considering level I, II, or Senior. The Hiring Manager will determine level based on skills and experience.
Preferred location: Atlanta, GA, but will consider other Anthem locations.
The Investigator I, II, or Sr. is responsible for the independent identification, investigation and development of complex cases against perpetrators of healthcare fraud in order to recover corporate and client funds paid on fraudulent claims.
Primary duties may include, but are not limited to:
Claim reviews for appropriate coding, data mining, entity review, law enforcement referral, and use of proprietary data and claim systems for review of facility, professional and pharmacy claims.
Responsible for independently identifying and developing enterprise-wide specific healthcare investigations and initiatives that may impact more than one company health plan, line of business and/or state.
May interface internally with Senior level management and legal department throughout investigative process.
May assist in training of internal and external entities.
Assists in the development of policy and/or procedures to prevent loss of company assets.
May be called upon to represent the Company in court proceedings regarding research findings.
Health insurance experience required with understanding of health insurance policies, health insurance claims handling and provider network contracting.
Develops and maintains a high degree of rapport and cooperation with the Federal, State and local law enforcement and regulatory agencies which can assist in investigative efforts.
- Requires BA/BS degree, 2+ years related experience preferably in health insurance, law enforcement; or any combination of education and experience, which would provide an equivalent background.
- Requires BA/BS degree, 3+ years related experience; or any combination of education and experience, which would provide an equivalent background. Fraud certification from CFE, AHFI, AAPC or coding certificates preferred. Knowledge of Plan policies and procedures in all facets of benefit programs management with heavy emphasis in negotiation preferred.
Requires BA/BS degree, 5+ years related experience in healthcare insurance and healthcare insurance investigation, law enforcement or any combination of education and experience which would provide an equivalent background.
Professional certification of CFE, AHFI, CPC, Paralegal, RN, JD or other job related designation preferred.
Knowledge of Plan policies and procedures in all facets of benefit programs management with heavy emphasis in negotiation preferred.
Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and is a 2017 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at antheminc.com/careers.
An Equal Opportunity Employer/Disability/Veteran